Becoming a Member of the New York Proton Center Patient Alumni Network

It was our great pleasure to provide your proton therapy treatment. We would like to stay in touch and invite you to become a member of our Patient Alumni Network (the "Alumni Network"). The Alumni Network is open to anyone who received proton therapy at the New York Proton Center ("NYPC").

As a member of the Alumni Network, you will receive the following benefits:

♦ Be invited to free virtual and in-person social, educational, and wellness programs

♦ Be sent periodic newsletters and updates (by e-mail and/or mail) with tips for healthy living and the latest news about NYPC and proton therapy

♦ Receive occasional requests from NYPC to get your opinions on patient experience or alumni initiatives

♦ Provide mentorship (at your option) to future NYPC patients

In addition to the benefits described above, NYPC may reach out to you if you check any boxes below indicating that you are interested in some or all of the following additional activities:

Are you willing to speak with or mentor other NYPC patients considering or beginning proton therapy for the same type of cancer?

Are you willing to have your proton therapy story shared on the NYPC website or social media channels?

Are you willing to join focus group discussions asking for patient opinions about NYPC initiatives?

To join the NYPC Alumni Network, please provide the following information:

First Name *

Last Name *

Address Line 1

Address Line 2

City

State

Zip

Country

Email *

Phone

Radiation Oncologist *

By checking this box, I agree to become a member of the NYPC Patient Alumni Network and to the terms and conditions contained in the NYPC Alumni Network Membership Terms, Conditions, and Privacy Practices *

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